Referral to emergency

If any of the following are present or suspected, please refer the patient to the emergency department (via ambulance if necessary) or seek emergent medical advice if in a remote region.

  • Significant haemoptysis or haemodynamically unstable

Please contact the on-call registrar to discuss your concerns prior to referral.

For clinical advice, please telephone the relevant specialty service.

Central Adelaide Local Health Network

Northern Adelaide Local Health Network 

Southern Adelaide Local Health Network

  • Flinders Medical Centre, request Respiratory Consults Registrar (08) 8204 5511

Exclusions

  • cough present for less than eight weeks

Triage categories

Category 1 (appointment clinically indicated within 30 days)

  • nil 

Category 2 (appointment clinically indicated within 90 days)

  • nil 

Category 3 (appointment clinically indicated within 365 days)

  • cough present for greater than eight weeks with normal chest x-ray (CXR) and normal spirometry and no improvement following treatment trial as below

Essential referral information

Completion required before first appointment to ensure patients are ready for care. Please indicate in the referral if the patient is unable to access mandatory tests or investigations as they incur a cost or are unavailable locally.

  • a summary of the clinical features of the cough (history, examination, investigation findings and any prior therapies)

Additional information to assist triage categorisation

  • duration, severity and timing of cough
  • any syncope, incontinence, shortness of breath (SOB) associated with cough
  • other relevant symptoms and co-morbidities e.g. respiratory symptoms (sputum, haemoptysis, breathlessness, wheeze), post-nasal drip, gastro-oesophageal reflux disease (GORD), history of atopy or ear, nose and throat (ENT) problems, anxiety, allergies
  • relevant examination findings
    • check uniform lung expansion and any percussive changes
    • clubbing, hoarse or nasal speech
    • movement of chest, percussion note, auscultation, pulse oximetry
    • signs of heart failure
  • medications including results of treatment trial as above and response to bronchodilators
  • smoking and occupational history
  • diet
  • pets
  • spirometry
  • sputum microscopy culture sensitivities (MCS)
  • blood results
    • full blood count (FBC)
    • electrolytes
    • liver function tests (LFTs)
    • renal function
    • C-reactive protein (CRP)
    • erythrocyte sedimentation rate (ESR)
  • imaging findings: all patients with chronic cough should have a chest x-ray and computed tomography (CT) imaging should be carefully considered based on age, clinical features and risk factors particularly for lung cancer
  • nasopharyngeal swab for Bordetella pertussis
  • relevant allied health/diagnostic/imaging reports (including location of company and accession number)
  • additional symptoms e.g. voice change, swallowing difficulty
  • any diurnal variation in severity (e.g. nocturnal or positional)
  • triggers e.g. air temperature, food, talking, exercise
  • spirometry pre and post bronchodilator
  • revious gastroscopy findings
  • detailed lung function (gas transfer, lung volumes, arterial blood gas)
  • echocardiogram, electrocardiogram (ECG)
  • thyroid function, antinuclear antibody

Clinical management advice

Before specialist referral, consider treatment trial for chronic cough:

  • smoking and vaping cessation should be strongly encouraged at every opportunity
  • ensure occult sino-nasal disease, unresolved infectious bronchitis and acid reflux have been considered and treated appropriately. Angiotensin-converting enzyme (ACE) inhibitors should be ceased, and an alternate medication substituted (e.g. angiotensin 2 receptor antagonists)
  • trial of proton-pump inhibitor (PPI)
  • if unsuccessful, or symptoms of post nasal drip, commence a six-week trial of intra nasal steroid
  • if unsuccessful, or evidence of asthma, commence a four-to-eight-week trial of inhaled steroids
  • if unsuccessful, and appropriate in the clinical context (and not indicated earlier) complete computed tomography (CT), chest scan (including high resolution images) and refer to specialist

Other strategies for consideration include:

  • treat bacterial bronchitis if present
  • cough syrups containing non-opioid agents such as dextromethorphan

Clinical resources

Consumer resources

Reason for request

  • to establish a diagnosis
  • for treatment or intervention
  • for advice and management
  • for specialist to take over management
  • for a specified test/investigation the General Practitioner cannot order
  • for other reason (e.g. rapidly accelerating disease progression)
  • transfer of care from another tertiary service
  • clinical judgement indicates a referral for specialist review is necessary.

Patient demographic details

  • full name, including aliases
  • date of birth
  • residential and postal address
  • telephone contact number/s – home, mobile and alternative
  • Medicare number, where eligible
  • name of the parent or caregiver, if appropriate
  • preferred language and interpreter requirements
  • identifies as Aboriginal and/or Torres Strait Islander

Clinical modifiers

  • impact on employment
  • impact on education
  • impact on home
  • impact on activities of daily living
  • impact on ability to care for others
  • impact on personal frailty or safety
  • identifies as Aboriginal and/or Torres Strait Islander

Other relevant information

  • Willingness to have surgery, where surgery is a likely intervention.
  • Choice to be treated as a public or private patient.
  • Compensable status, e.g. DVA, Work Cover, Motor Vehicle Insurance, etc.
  • Relevant social history, including identifying if you feel your patient is from a vulnerable population, under guardianship/out-of-home care arrangements and/or requires a third party to receive correspondence on their behalf.
  • Triage of a specialist outpatient referral is based on clinical decision making to allocate an appropriate urgency categorisation.
  • Where appropriate and where available, the referral may be streamed to an associated public allied health and/or nursing service. Access to some specific services may include initial assessment and management by associated public allied health and/or nursing, which may either facilitate or negate the need to see the public medical specialist.
  • A change in patient circumstance (such as condition deteriorating or pregnancy) may affect the urgency categorisation and should be communicated as soon as possible.
  • All new referrals will be triaged by a consultant and appointment times scheduled according to clinical urgency.